Imagine that you went to visit your Kaiser Permanente doctor and received some service (not as serious as cancer treatment or heart surgery, thank goodness). By coincidence, your husband had gone to the very same Kaiser Permanente doctor and received the very same service, only three months earlier.
When the bills come, you notice that the charges on your husband's bill are different than yours.
- Hubby's bill lists "Service A" (an OUTPATIENT item) with list price of $900,
- your bill lists "Service B" (an INPATIENT item) with a much higher list price of $2500.
But you were never an inpatient, you never spent a night in the hospital. You and hubby both took the exact same outpatient test.
So you call the Kaiser Permanente billing department and say, "There's apparently been a mistake. Hubby and I both took the same test, but I am being charged about 3 times more than he was. I was charged for Service B, but I should have been charged for Service A." They say, the billing codes are set in the doctor's office, you need to call the doctor to get a billing code issue fixed.
So you do that. The Kaiser Permanente doctor's office confirms that you and hubby received the exact same service. In fact, they go on to tell you that they don't even offer Service B. But they say that they don't actually apply billing codes to their records, they use some other kind of codes that "get translated" into billing codes by another organization downstream. It is apparent that they do not have a close working relationship to this organization. But they are professional and sympathetic, and say they'll try to get it fixed. Apparently, they fail.
I won't share all the gory details with you. But today I learned that my request to have an accurate billing code applied to my Kaiser Permanente bill was denied. Kaiser told me that "we regret that we are unable to meet your service expectations". WTF?
By applying the "wrong code" to my bill, Kaiser Permanente will collect "more money from me" (and all of the many other people who are getting this increasingly popular test, which is for a condition called sleep apnea).
//snark on
But I'm sure that has nothing to do with it.
//snark off
And if hubby and I didn't, by freakish coincidence, suffer from the same medical condition and obtain the exact same service from the exact same doctor, I never would have known about this myself. As a patient, you assume that you will be billed correctly for the actual services that you receive.
Based on how I"ve been treated, I suspect that Kaiser Permanente has figured out that by using incorrect codes, they can collect more money from patients, especially naive patients who don't have PhD's in medical billing codes (and isn't that pretty much all of us?)
FYI, the increased expense to me hurts but won't break our piggy bank. It could have been much worse, I suppose; they could have charged me for a different service that I did not receive, like heart surgery. But I'm feeling bullied by this insurance giant, who I believe is not acting in good faith with me. The secret to dealing with a bully is to tell someone what happened, so I'm publishing this diary.
There's more below about how Kaiser Permanente "work[ed] to ensure that [my] future experiences [were] positive," as they put it.
Here's more information from the most relevant parts of my rejection letter:
We shared your concern that due to a coding error, you were erroneously charged for the xxx test on xxx with the Director at the Kaiser Permanente Patient Financial Services Department for review and response.
Okay, they had my attention. They went to the top.
A Collector responded on behalf of the Director
Translation: for whatever reason, the guy at the top asked some lower level peon called a "Collector" to take care of it. From the job title, do you think they were completely unbiased when considering my request? I wonder what the job responsibilities of a "Collector" are?
FYI, there is no mention in the letter of the "Collector" ever contacting the doctor's office to ensure that the correct billing code was applied to my bill.
and shared that a review of your record indicates that the charges incurred are in accordance with your Plan benefits ...
What kind of an answer is that? I tell them that a coding error was made, that I was being billed for
a service that is not even offered by the doctor at all, and they reply with gobbledy-gook unrelated to the topic at hand. Q: What's for dinner? A: We shall eat at 6:00, promptly.
Because I have an inflated "list price" on my bill, the part that "I am responsible for" is about triple the amount my husband had to pay for the exact same service using the exact same insurance.
The letters I received are chock full of nice-sounding-but-insincere weasel words. The first one sent to confirm that my "complaint" had been received included:
We sincerely apologize for not meeting your expectations and will work to ensure that your future experiences are positive.
Okay.
[All of the letters start out this way. It's a nice touch, don't you think?]
If you have any other information which was not already provided to [us] but that you would like Health Plan to consider, we must receive it it no later than [3 days from the date the letter finally came in the snail mail]
No email address was provided (for my convenience, obviously). So I faxed a letter to them by their deadline, and asked for confirmation from my case manager that it was received. She never returned my call, even though I left several voice messages; I even filed another complaint (now that I had learned how to do it) because she could not find time to provide such confirmation to me. So much for "work[ing] to ensure that your future experiences are positive."
A decision will be made based on all of the information available to us at the time of the review.
There is a zen-like beauty in the stupidity and evilness of this sentence, I think.
Translation: we might not do squat to investigate, but if/when we make a bad decision then, our excuse will be that "We made the best decision that we could at the time. What else could we do?". I made d*mn sure my letter to them included all of the relevant information (whether I had communicated it before or not), including the fact that the doctor does not even offer the service listed on my bill. As it turned out, they apparently even ignored the information that I handed to them on the proverbial silver plate.
They basically wrote a rejection saying "blah, blah, blah, we denied your request, for reasons that don't make any sense but we can do it and so we did, too bad so sad for you. Have a nice day."
Apparently, the next step in the process is for me to submit a complaint to a government agency, the California Department of Managed Health Care, who will determine if I qualify for an Independent Medical Review (IMR). And also pay Kaiser Permanente's extortion so that I don't damage my credit rating.
Before we go, quick quiz: who is the health insurance giant that is "unable to meet [my] service expectations" of billing me correctly for the service that I actually received from them?
If you answered Kaiser Permanente you are right! Ding! Ding! Ding! Keep that in mind during your next open enrollment opportunity. And feel free share my sad tale with any of your friends who share the same "service expectations" from their own healthcare providers.
5:33 PM PT: I have gotten a lot of wonderful support and advice in the comments below, this is such a great community and I am truly thankful for it. I wanted to share my immediate next steps with you:
1) I am keeping detailed notes, and as a part of that I decided to call the “Sleep Clinic” (i.e. the doctor's office at Kaiser) to find out if in fact anyone ever contacted her during the “review of my request”. I'm waiting to hear back from her, but suddenly realized something during that small transaction. The official name of the office that treated me is called the “Outpatient Sleep Clinic”. Obviously, a clinic with that name is not going to be providing any inpatient services to anybody.
2) I was going to try to call an “assistant medical administrator” per the advice of bahaba, but then I realized that I wanted a little bit more than to just have this problem go away. The actions on Kaiser's part toward me were not accidental, they were intentionally trying to screw with me, and that rather ticks me off. I was also worried that even if Kaiser fixes my billing problem, there is nothing really to stop them from fraudulently billing other patients. So I decided to get more information about filing a complaint with the DMHC.
I quickly learned that the information Kaiser had given me in a handout was misleading (surprise, surprise) in that it looked like it was going to be a giant pain to deal with the DMHC, and it's not. It's almost as if Kaiser wants to discourage me from disputing their decision, lol.
So I've decided to file a complaint with the DMHC, and see where that goes. The DMHC is confident that they won't send me to a collections agency while their process is underway, but I'm not sure whether we'll pay the disputed amount and obtain a refund later or refuse to pay more than what we think we actually owe.